Chamber Group Insurance Resource Library


Administration Forms


Administration and Claims Guide

Application for Over-Aged Disabled Dependents

Application to Insure a Dependent Over 21

Beneficiary Designation

Benefit Increase Waiver

Employee Application

Employee Change Request

Employee Statement of Dependent Health

Employee Statement of Health

Employee Termination Reinstatement Request

Firm Contact and Address Change Form

Group Benefit Plan Waiver

Group Life and Accidental Death and Dismemberment Insurance

Intent to Convert Accidental Death and Dismemberment Coverage

Intent to Convert Group Life Insurance Coverage

Optional Life Insurance Application

Optional Life Insurance Statement of Health

Request for Pre-Authorized Payment Plan

Request to Terminate Firm Coverage

Salary Change Request

Statement of Income Worksheet

Claim Forms


Cost Plus Reimbursement

Dental Accident Claim

Dental Claim

Direct Deposit of Health and Dental Benefit Payments

Employee Reimbursement Form for ASSURE drug claims

Extended Health Claim

My Benefits eClaims

Understanding Long Term Disability Claims

Voyage Assistance